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Babies with Positional Skull Flattening May Not Benefit from Wearing Corrective Helmets

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Babies with Positional Skull Flattening May Not Benefit from Wearing Corrective Helmets

Written by Sandra Levy
| Published on May 2, 2014

In a new study, researchers advise against using corrective helmets for babies with positional skull flattening, after finding there wasn’t any noticeable difference in outcomes of babies who had helmet therapy and those who didn’t have therapy.

Parents who have children with positional skull flattening may opt to
have their children wear corrective helmets. According to a new study, published in the journal BMJ,
babies with this condition do not benefit from wearing
these helmets. In fact, the study found that at two years of age,
children who have no treatment have similar outcomes.

One in Five Babies Under Six Months Have Skull Deformation

Skull
deformations, known as positional skull deformation or plagiocephaly,
occur in about one baby in five under the age of six months, as a result
of lying in the same position for long periods. The condition has
become more common as a result of campaigns, such as Back to Sleep,
which advise parents to lay their babies on their backs to sleep to
reduce the risk of sudden infant death syndrome (SIDS).

Positional
skull deformities can develop in the early months of life because a
baby's skull is growing fast and the skull bones are still soft enough
to change shape as a result of pressure.

The researchers, based in
the Netherlands, studied 84 healthy full-term babies who had a moderate
or severe positional skull deformation – either plagiocephaly, where
one side of the head becomes flattened and the ears can become
misaligned, or brachycephaly, where the back of the head is flattened
and the front of the skull may bulge.

Babies Wore Helmets for Six Months

Beginning
at age six months, half the babies wore rigid, custom-made, closely
fitting helmets for 23 hours a day for a six-month period. The other
half did not receive treatment.

At two years of age, detailed
measurements of their head shape showed no significant difference in the
degree of improvement in skull shape between the two groups.

The
researchers reported no significant difference in the two groups’
recovery from treatment. About 25.6 percent of babies who had helmet
therapy had a full recovery at two years of age, compared with 22.5
percent of those who didn’t have any treatment. Both groups showed
similar improvements, although only a quarter made a full recovery to a
normal head shape.

Parents Reported Children Had Side Effects

According
to the study, all of the parents whose babies wore a helmet reported
side effects. Skin irritation was reported by 96 percent of parents.
Seventy-seven percent of parents said they felt hindered from cuddling
their baby. An unpleasant smell was mentioned by 76 percent of parents,
while sweating was reported by 71% percent of parents. Finally, almost
one third said pain was a side effect.

When it came to being
satisfied with their child’s head shape at two years of age, parents of
both groups were generally satisfied. The average satisfaction score was
4.6 out of 5 among those whose babies had worn helmets compared with
4.4 among those whose babies had no treatment.

Researchers Advise Against Wearing Helmets

Commenting
on the greatest impact of the study’s findings, lead study author
Renske van Wijk, MSc., Department of Health Technology and Services
Research at the University of Twente, told Healthline,“Based on the
equal effectiveness of helmet therapy and skull deformation following
its natural course, and high prevalence of side effects, such as skin
irritation, problems with babies accepting the helmet, and parents
feeling hindered from cuddling their baby because of the helmet, as well
as the high costs associated with helmet therapy, we discourage the use
of a helmet as a standard treatment for healthy infants with moderate
or severe skull deformation.”

When queried whether the researchers
were surprised by any of the findings, van Wijk said, “We were
surprised that we didn’t find any relevant differences between groups.
Furthermore, at the age of two, only 25 percent of infants who were
included in the study showed full recovery. Despite this, parents of
infants in both groups showed high satisfaction scores, on average 4.5
out of 5, with their infants' head shapes.”

“For parents of five-
to six month-old infants with moderate or severe skull deformation, we
would discourage helmet therapy in healthy infants. But parents with
concerns should always speak to a doctor,” said van Wijk.

Emphasizing
that it remains vital for parents to continue laying babies on their
backs to sleep to reduce the risk of SIDS, van Wijk said, “Additionally,
it should be advised to put a baby on its tummy while awake from an
early age on to prevent positional skull deformities. Furthermore,
changing sides when bottle feeding and altering the position of the head
each sleep (left to right) are important prevention measures for
positional skull deformation, but can also be used when a deformation
has been detected. When you have concerns about a positional preference
or flattening of the skull, don’t wait, but ask for advice on
(re)positioning your infant.”

Further Research Needed

In
an editorial, accompanying the article on the study, professor Brent
Collett, Ph.D., from the University of Washington School of Medicine,
said parents would want to know whether treatment would result in
improvements above and beyond what would be expected by not doing
anything at all.

Collett went on to say future research is
warranted to learn whether children with the most severe PPB (positional
plagiocephaly and brachycephaly), who were excluded from this trial,
show meaningful improvement. Additional work “incorporating behavioral
and public health strategies to promote 'tummy time' and similar
positioning strategies should be explored," concluded Collett.

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